Provider Demographics
NPI:1982600862
Name:MEDICAL SERVICE ASSOCIATES OF XENIA INC
Entity Type:Organization
Organization Name:MEDICAL SERVICE ASSOCIATES OF XENIA INC
Other - Org Name:MEDICAL SERVICE ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR PHYSICIAN PRACTICES
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DRENTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-352-2788
Mailing Address - Street 1:1141 N MONROE DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-1619
Mailing Address - Country:US
Mailing Address - Phone:937-352-2787
Mailing Address - Fax:937-352-3788
Practice Address - Street 1:50 N PROGRESS DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-2666
Practice Address - Country:US
Practice Address - Phone:937-372-7691
Practice Address - Fax:937-374-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2530265Medicaid
OH2330256Medicaid
OH2521391Medicaid
OH0220415Medicaid
OH2530283Medicaid
OH2530274Medicaid
OH2530292Medicaid
OH9218054Medicare PIN
OH9218057Medicare PIN
OH2521391Medicaid
OH9218055Medicare PIN
OH2530274Medicaid
OH9218058Medicare PIN
OH2330256Medicaid
OH9218059Medicare PIN